7 Physician Patient Arbitration Agreement Preface: I, Dr. Jhonny Salomon, have decided under Florida Law to practice without Malpractice insurance. Under this practice, this Arbitration Agreement ( Agreement ) should be read carefully and fully understood. If you have any questions before or after reading and signing this statement please ask the staff or my office manager. Please read this document clearly. Thank you for your consideration. Article 1: Agreement to Arbitrate: It is understood that my dispute as to medical malpractice that is, as to whether any medical services rendered under this contract were unnecessary, authorized or were improperly, negligently, or incompletely rendered, will be determined by submission to arbitration as provided by the Florida Arbitration Code, Chapter 682, and not by a lawsuit except as Florida law provides for judicial review or arbitration proceeding. Both Parties to this contract, by entering into it, are giving up their constitutional rights to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration. Article 2: All Claims Must Be Arbitrated: It is the intention of the parties that this Agreement bind all parties whose claims may arise out if related treatment or services provided by the physician including any spouse or heir of the patient or any children, whether born or unborn, at the time of the occurrence giving rise to any claim. In the case of a pregnant mother, the term patient herein shall mean both the mother and the mother s expected child or children. All claims for monetary damages exceeding the jurisdictional limit of the small claims court against the physician, and the physician s partners, associate, association, corporation or partnership, and the employees, agents and estates of any of them must be arbitrated including, without limitation, claims for loss of consortium, wrongful death, emotional distress or punitive damages. Filling of any action in any court by the physician to collect any fee from the patient shall not waive the right to compel arbitration of any malpractice claim. Article 3: Procedures and Applicable Law: A demand for arbitration must be communicated in writing to all parties and must be within the time frame set forth in F.S dealing with medical malpractice. Each party shall select an arbitrator (party arbitrator) within thirty days and a third arbitrator (neutral arbitrator) shall be selected by the arbitrators appointed by the parties within thirty days of demand for neutral arbitrator by either party. Each party to the arbitration shall pay such party s prorated share of the expenses and fees to the neutral arbitrator, together with other expenses of the arbitration incurred or approved by the neutral arbitrator, not including counsel fees or witness fees, or other expenses incurred by a party for such party s own benefit. Arbitration shall take place within 30 days after the completion of discovery as provided in the Florida Rules of Civil Procedures (Rules ) and the decision of the arbitration panel shall be binding upon the parties for all purposes. The time to responding to discovery requests shall be 10 days. All discoveries shall be completed within 2 months after the appointment of the panel of arbitrators, unless the time for the discovery is extended for good cause by the panel. The arbitration panel shall decide any disputes regarding discovery. The arbitration panel is expressly authorized to award all reasonable fees and costs, including attorney s fees, to the prevailing party against any part who has violated this Agreement. The parties agree that the arbitrators have the immunity of a judicial officer for civil liability when acting in the capacity of arbitrator under this contract. The immunity shall supplement, not supplant, any other applicable statutory or common law provisions. 7

8 Either party shall have the absolute right to arbitrate separately the issues of liability and damages, upon written request to arbitrate separately the issues of liability and damages, upon written request to the neutral arbitrator. The parties consent to the intervention and joinder in this arbitration of any person or entity which would otherwise be proper additional party in court action, and upon such intervention and joinder any existing court action against such additional person or entity shall be stayed pending arbitration. Article 4: General Provision: All claims based upon the same incident, transaction or related circumstances shall be arbitrated in on proceeding. A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in civil action, would be barred by the applicable Florida statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein with reasonable diligence. With respect to any matter not herein expressly provided for the arbitrator shall be governed by the Florida Rules of Civil Procedure provisions relation to arbitration. I have read and understood all information presented to me before signing. I understand that I have the right to receive a copy of this Arbitration Agreement. (Patient s or Patient s Representative s Signature) Date If any provision of this Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and shall not be affected by the invalidity of any other provisions. 8

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